The County Attorney Mental Health Unit represents the State of Texas in mental health and intellectual disability commitment hearings and advocates on behalf of consumers of mental health and intellectual disability services regarding the delivery of those services in our community.

Specifically, the Mental Health Unit: Advocates for access to high quality mental health and intellectual disability services; Facilitates inter-agency collaboration for the development of solutions to problems in the mental health system; and Trains peace officers, medical professionals, social workers, guardians and others on how to access emergency mental health services.

A member of the Mental Health Unit chairs the Inter-facility Task Force to foster inter-agency collaboration to solve problems in the mental health system. Additionally, the office participates on the Jail Diversion Committee in trying to come up with ways to divert the mentally ill from jail and otherwise assist in matching them up with needed services be they follow up care for their mental health or housing or other services.

If you, a family member, or someone you know is in need of mental health services call the Local Crisis Hot Line at EHN 915-779-1800 or the National Suicide Prevention Hotline at 877-562-6467 or visit the EHN website at www.ehnelpaso.org. If you are able to get the person in need of help to EHN, the local mental health authority, for in-person screening go to 1601 Yandell, El Paso, Texas.

All hearings, to include probable cause and final hearings are held on Mondays and Thursdays of each week (unless those days are county holidays) beginning at 9:00 am at the El Paso Psychiatric Hospital, 4615 Alameda, El Paso Texas 79905 (MAP).

When and where are the court hearings?

All hearings, to include probable cause, final, modification, psychoactive medication, and status are held on Mondays and Thursdays beginning at 9:00 am at the El Paso Psychiatric Hospital at 4615 Alameda, El Paso, Texas 79905.

I believe my adult loved one is acutely mentally ill. How can I get them help?

If you believe that someone is, at present, likely to cause serious harm to themselves or others because of their mental illness, you may either come into the County Attorney’s Office on the 5th floor of the El Paso Courthouse, 500 E. San Antonio, or you may complete an application for Emergency Detention and submit it by fax or email. The applicant must be 18 years of age or older, must have first-hand knowledge of the person’s behavior, and state that they have reason to believe that the person evidences mental illness and because of their behavior and recent overt acts committed by them, they are in imminent harm to themselves and/or to others. The applicant must be willing to sign a notarized application.
If the person is actively attempting to commit suicide or is becoming dangerous, call 911 and ask for assistance from the police or sheriff’s office.

I am the guardian of an acutely mentally ill adult ward. How can I get them help?

A guardian has the authority to transport an adult ward to a mental health facility for the purpose of getting a preliminary evaluation. They may file an application for an ED in which they would state that they have reason to believe that the ward evidences mental illness and is in imminent danger of hurting themselves and/or others. If the person is actively attempting suicide or is becoming dangerous, call 911. While the guardian does not have the right to commit the ward for inpatient services, they should advise the probate court if the ward is detained and may be asked if they agree to the person staying in the hospital until the final hearing.

How can I get a mentally ill minor/ward admitted to a psychiatric facility?

A parent, managing conservator, or guardian of a minor may consent to the voluntary admission of the child/ward to an inpatient mental health facility. In Texas a child 16 or older may consent to admission to a hospital.

What forms hospitals need to submit to get a probable cause order?

The CME must be filled out by a physician and notarized. The application may be filled out by a non- physician. Please also provide the CA office with the Notification issued by a peace officer and the Application for ED and warrant accompanying that application, if applicable. These documents may be scanned and emailed to us or faxed. Email is preferred. If the judge approves the order a copy will be faxed to you.

What are the community resources available to help the mentally ill?

Here is a link to a non-exclusive list of resources in English and en Espanol for help.

What if a person needs treatment but still has a pending criminal case?

If an attorney has already been appointed to represent the person in the criminal case, please contact that person and work through them. You may also refer the attorney to the County Attorney’s office to try and coordinate cases. Unless the pending criminal case is for an assault- serious bodily injury, it will not prevent the civil commitment case from going forward.

How can I find out if a person is in psychiatric facility?

Much information about a mentally ill person who has a case pending is confidential and our office may not be able to release information to you, especially if the patient has told the facility to limit the release of information to certain persons. If the patient gives you their “medical ID number” you may get information directly from the facility about their treatment and verify that they are at the facility.

Is there a limit to the number of emergency detentions I can request?

The court process is available as often as the person meets criteria. You do not have a limit on how often you request help but know that the person must be in imminent harm to qualify for court intervention of this kind.

Is it allowed to present the paperwork in Spanish?

Yes we can accept your papers if they are in Spanish. All court papers will be submitted and filed in English. There will be a Spanish language interpreter at the court hearings. If you or the patient need assistance with a deaf interpreter or a foreign language interpreter for a language other than Spanish, please advise the office so that arrangements can be made in advance to have those interpreters at the court hearings.

Can the County Attorney’s Office answer my questions about the law?

Generally our staff can assist with procedural questions but are not in a position to give legal advice. They can refer your question to an attorney familiar with mental health issues who may be able to assist you further. Please know that this office represents the State of Texas in these matters and in doing so, cannot give you or the patient legal advice.

How can I request training in the involuntary mental health process for my agency?

Please fill out the attached training request form to better help us address your particular training needs.

Mental Health Court Process

Referral

A person can enter the mental health court process in a number of ways. A peace officer may complete a Notification of Emergency Detention and transport the person to a facility for a preliminary mental health evaluation if the officer has reason to believe that the person is mentally ill and presents a substantial risk of harm to self or others unless restrained and there is no time to obtain a warrant. In this situation the officer transports the person to the nearest appropriate mental health facility or emergency room for an evaluation and leaves the notification at the facility. No order is signed by a judge. Alternatively, any adult may file an Application for Emergency Detention to detain their mentally ill adult loved one when they are mentally ill and a significant danger to themselves or others. A non-family member such as a caseworker, a neighbor, or a co-worker may apply as well. Once the application is complete, it is submitted to a judge who will review it and determine whether they believe that the person is a danger to themselves and/or others. If the judge approves the application he/she will sign a warrant and the El Paso County peace officer will serve the warrant and transport the person to an appropriate facility for an preliminary psychiatric evaluation.

Evaluation

A preliminary psychiatric evaluation is conducted either after the peace officer leaves the person at the facility or after they serve the warrant on the person and then transport him/her to a facility. The person may be held at the facility for up to 48 hours for this purpose unless the time ends on a weekend or holiday in which case the ending time is extended. When the person no longer meets the criteria for detention then they are discharged. Should a physician determine that the person needs to remain as an in-patient for a longer period, then the facility may request an Order for Protective Custody which would allow the patient to be detained for another 72 hours. The protective custody order may only be requested through the probate courts by the County Attorney’s office.

Treatment

The patient is often first seen at a hospital emergency room where they remain until he/she is determined to be medically stable. Once stable, the patient is transferred to a psychiatric facility although often there is a waiting list to be so transferred. A hospital must have the appropriate paperwork in order to hold a patient under an involuntary admission. The Notification or Emergency detention order allow the person to be detained and evaluated. The person must still consent to medical treatment in the hospital setting assuming they are able to give consent. Psychoactive medication may be offered to the patient in the hospitals and/or in the mental health facilities. Generally psychiatric hospitals are not able to perform medical procedures which is why the person remains at the hospital until they are “medically cleared.”

Appointed counsel

Once the case for in- patient involuntary commitment has been filed with the probate court, an attorney is appointed by the court to interview the patient, review records and assist the person through the mental health legal process. The attorney advocates for the rights of the patient as well as the wishes of the patient. Their duties are spelled out in the law. They do not represent the family, only the patient. An attorney is assigned by the court to serve for a month at a time for all the hearings that are set during that month.

Probable cause hearing

Within 72 hours of being detained under the protective custody order, the patient is entitled to have a probable cause hearing. This hearing is to determine if there is “probable cause” to further detain the person until their final hearing. A judge makes the decision after a court hearing as to whether the person should be kept in the facility until their final hearing because the person presents a substantial risk of harm to self or others to the extent that they cannot remain at liberty. The patient may sign a waiver agreeing to stay in the hospital until the final hearing in which case there would be no hearing. An attorney would assist the patient with the handling of this matter.

Final Commitment Hearing

A final commitment hearing follows the probable cause hearing. The patient is entitled to be present and to a jury trial, but both may be waived by the patient. An attorney is present for the patient. A record is made and a court interpreter is available should the patient or a witness need the assistance of an interpreter. If the judge finds by clear and convincing evidence that the patient is mentally ill and as a result is likely to cause serious harm to themselves or others or is experiencing substantial deterioration of his/her ability to function independently and is unable to make a rational and informed decision as to whether to submit to treatment, then the court will order a temporary commitment not to exceed 90 days. That commitment may be either an in-patient or an out-patient commitment. Should the patient no longer meet criteria for an involuntary commitment, then they would be discharged or admitted as a voluntary patient. The judge doesn’t decide which facility the patient should be committed to. In El Paso patients are either committed to the El Paso Psychiatric Center, El Paso Behavioral Health Systems, or the Hospitals of Providence- Memorial Campus if a geriatric patient.

If the patient meets criteria for an extended commitment, they may be under a one year commitment order. Both the temporary and the extended commitments may be agreed to by the patient and thus no hearing would occur in that event.

While subject to an in-patient commitment order, should the patient refuse to take their medication or stop taking it, it is possible for the psychiatrist to request the court to enter an order for psychoactive medication. Under this order, the patient’s consent would not be required. A patient may not agree to the entry of such an order and there must be a hearing if such relief is requested.

Release

The treating doctor decides when a patient should be released from the involuntary mental health commitment order. The judge does not decide when the patient should be released. Generally social workers and case managers are responsible for making a discharge plan for the patient and they will consult with family members in coming up with a plan that may include follow up appointments, prescriptions and related services.

Minors

Generally, involuntary commitments are not available for minors. There are some narrow exceptions to this rule pertaining to commitments under the Juvenile Justice Section of the Texas Family Code or under those portions of the Texas Health and Safety Code relating to intellectual disability commitments.

Intellectual Disability Commitments

In rare circumstances a person, to include a minor, may be committed under the laws relating to persons with intellectual disabilities. If you have a question about this kind of commitment, please consult an attorney or call the County Attorney’s Office at 546-2084.